Question from Road: Gonna Fire the Nurse??

Any one who has worked in or around med-mal or teaches disclosure has heard this question before:

"Well, you gonna fire the nurse? She hurt Daddy! What about the doctor...gonna fire him too? I want their licenses...NOW!!!"

During a disclosure training seminar last week, we had this question brought up and were asked how to address it. Well, how do you handle this heated question from an angry patient or family? You can't be off-putting by saying "none or your business" or "I can't tell you" because that will only increase the anger. However, you can't exactly spill the beans because there are privacy concerns when it comes to the employment status of your people. It's a fine line to walk....but walk it you must.

I think what you have to do when confronted with this situation/question, is say the following in a very direct, almost forceful tone: "I am sorry you feel this way, and we will be talking to Nurse Smith and discussing your complaint with her." This is an action-orientated statement that is truthful without going too far --- because you want to get Nurse Smith's side of the story, review the chart, and talk with other people. Maybe the patient is - heaven forbid - wrong! Let's not prematurely throw Nurse Smith under the bus.

Even better, with a good disclosure program you will often have a chance down the road to bring Nurse Smith - as well as other clinicians, including docs - back into the picture with the patient and family. If it was a mistake, bad care, etc, getting Nurse Smith and Doctor Jones to apologize to the patient or family can be very meaningful for all sides. This can provide closure for all sides, be very satisfying for the customer, and be a great quality improvement tool for staff. And it can alleviate the need for the firing!

I have had numerous nurses tell me stories of their earlier nursing days when they made a mistake (sometimes horrible mistakes) and their nursing manager literally dragging them to the bedside to tell the patient/family --- and it being a wonderful experience. The patients forgave them and they learned from the event.

Even if it wasn't a mistake - perhaps a known complication or misunderstanding - having Nurse Smith empathize, communicate and try to re-connect with the customer can be powerful too, and, again, alleviate the need for the "firing."

Moreover, we have to remember that not every patient or family will want to "fire the nurse or doctor." Plenty of stories out there of a serious event happening and the patient is actually more concerned about how the nurse or doc is doing, and feels sorry for them!

But, what about "firing" the nurse or doctor? Well, if you have clinician who is a frequent flyer, sure, they need to go. However, if you have a caring person who made an honest mistake, that's a different story. I'll never forget these words from an administrator of a large nursing home system: "When a good person has made an honest mistake you have actually made an investment in that person -- and you are foolish to fire them. Because this staff member will work very hard to make sure this mistake never happens again!" Good point.

Then there's another way to look at it that was shared with me by a former nursing educator: "If a person is very remorseful following a mistake, they can be recovered...it's the person who shows no emotion, care, or concern following a mistake that probably needs to be fired."

Finally, you Don't be so quick to fire a good person to placate an angry family member.....instead use your disclosure program to try to bring real healing and closure to all sides and improve your quality. And look for staff who are remorseful post-event, and remember the investment you have in them going forward.

Hey, have a question, problem, or challenge with your disclosure program? Do you need to discuss a case, or just kick around some ideas? Sorry Works! provides disclosure consulting for hosptials, insurers, and clinicians. Just call 618-559-8168 or doug@sorryworks.net.